Panel Member 5 16.37 Panel Member 4 16.50 Panel Member …...Panel Member 6 15.81 Panel Member 7...
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Improving End-of-Life Care Quality through Individualized PCP Reporting Michael Kersten, MPH; Terry Hill, MD; Nathaniel Robbins; Brook Calton, MD; Vidah Johnston, RN; Vicky Siauw, PharmD Hill Physicians Medical Group, San Ramon, CA: [email protected] BACKGROUND Medical groups, such as our independent physician association (IPA), and even health plans have usually lacked timely and complete data on deaths within their population. Without dates of death, health systems cannot discern patterns and variations of end- of-life care and quality across their populations. Thankfully, the California Department of Public Health (CDPH) has begun making this information available in rapid turn-around fashion. This poster shows how one IPA in Northern California is using this data to prompt individual physicians and regions to reflect on the quality of care given to their decedents. PROJECT DESCRIPTION Population views are invaluable for grasping systemic issues, but for a provider there is nothing comparable to seeing one’s own specific performance and the names of one’s own decedents. To create the provider report we envisioned, we partnered with our analyst to clean the data and prepare it for a clean pull into Tableau. We wanted to compare PCPs in the same area (“Your panel”) for key utilization measures in the last 90 days of life for members with serious illness or over the age of 72. The table in the upper right indicates how many of this provider’s decedents were coded as having advance care planning (ACP) before death. The patient level detail on the bottom shows data for each decedent: ACP prior to death, availability of a palliative care benefit (per health plan), and last 90 days utilization. As an IPA, we do not have hospice enrollment data. Only patients with one or more of the following were pulled into this report: age 72+, CHF, COPD, CKD, cancer, end stage liver disease, frailty, AIDS, MS, ALS, stroke, dementia. METHODS • The project required us to apply to the CDPH for monthly death files that included all California decedents. We received these files and ran our established matching process (EMPI) with a further logic that excluded any matched patients with post- death medical claims after date of death (DOD). • Once DOD was established for matched HPMG patients, our analyst generated new data points for admits, bed days, and ER visits in the 90 days prior to death. • We also determined whether decedents had ACP in the years prior to death, based on codes 99497/99498, yielding the table in upper right corner (Decedents With and Without Advance Care Planning). • The End of Life Detail table on the bottom right shows the same data at the patient level, with the addition of health plan and palliative care (PC) benefit. PC benefits are specific to plan and geography, so we indicated instances where it would have been available for each decedent. • Not shown are additional analyses of aggregate variation across disease states, multimorbidity, and age. CONCLUSION The creation of this report is an innovative achievement for an IPA like ours—one that could not have been possible without the state’s policy shift and the many advocates who petitioned the CDPH. This report was rolled out to our 1,500 PCPs in the fall of 2018 with an ACP Provider Packet. While quantitative evaluation must await additional data, many of our providers have expressed deep concern at the low percentage of decedents with ACP and recognized the call to action. Discharge Dt Patient ACP Code* TCM Code Has IP Followup Visit Visit Lag Time (Days) 4-0-18 Patient 1, Female, b.1927 No No No – Patient 2, Female, b.1942 No No No – 3-27-18 Patient 3, Male, b.1932 No No No – 3-17-18 Patient 4, Male, b.1929 No No No – Patient 5, Male, b.1938 No No No – Patient 6, Male, b.1927 No No No – 3-08-18 Patient 7, Male, b.1956 No No No – 2-06-18 Patient 8, Male, b.1943 No No No – 2-04-18 Patient 9, Male, b.1934 No No Yes 2 1-27-18 Patient 10, Male, b.1956 No No Yes 4 1-19-18 Patient 11, Female, b.1941 No No Yes 7 1-16-18 Patient 12, Female, b.1954 No No Yes 4 1-16-18 Patient 13, Male, b.1932 No No No – 1-16-18 Patient 14, Male, b.1943 No Yes Yes 3 1-16-18 Patient 15, Male, b.1956 No No Yes 10 Patient DOD Last Office Visit Dt Prior ACP HP PC Benefit ER Visits IP Days IP Admit Patient 1, Female, b.1931 2-15-18 2-8-18 No BS Yes, Most Areas 2 5 2 Patient 2, Male, b.1934 8-18-17 8-4-17 Yes BS Yes, Most Areas 2 27 3 Patient 3, Female, b.1943 7-20-17 7-17-17 No UH Yes, Outpatient 4 46 5 Patient 4, Male, b.1926 10-25-17 10-24-17 No HN Yes, Limited 1 0 0 Patient 5, Male, b.1938 3-14-18 3-9-18 No UH Yes, Outpatient 0 3 1 Patient 6, Female, b.1931 8-18-17 8-4-17 No UH Yes, Outpatient 1 3 1 Patient 7, Male, b.1936 6-30-17 2-9-17 No UH Yes, Outpatient 1 75 2 Decedents Patient Death With ACP ACP Percent You 7 1 14.3% Your Panel 85 17 20.0% POST ACUTE AND SERIOUS ILLNESS: INPATIENT FOLLOW-UP CARE Q2 2017 THROUGH Q1 2018 POST ACUTE AND SERIOUS ILLNESS: END OF LIFE CARE QUALITY Q2 2017 THROUGH Q1 2018 Decedents With and Without Advanced Care Planning (ACP) Inpatient Followup Visit Detail (Last 15 Admits) End of Life Detail (Last 90 Days of Life) © 2018 Hill Physicians Medical Group, Inc. | HP-MSCL18-009 2 4 6 8 10 12 14 16 18 20 22 24 26 Number of Days Average Days from Discharge to Follow-up Visit for Patients Havong a Serious Illness or Age 72+ Auburn Folsom Area Panel Member 1 24.63 Panel Member 2 20.29 Panel Member 3 16.64 Panel Member 4 16.50 Panel Member 5 16.37 Panel Member 6 15.81 Panel Member 7 14.43 Panel Member 8 13.12 Panel Member 9 13.00 Goal (10 Days or Under) Panel Member 10 12.27 Panel Member 11 10.92 Panel Member 12 10.76 Panel Member 13 9.00 Panel Member 14 8.71 Panel Member 15 8.47 Panel Member 16 7.50 Panel Member 17 7.33 Panel Member 18 7.16 Panel Member 19 6.83 Panel Member 20 5.64 You 10.45 Decedents End of Life Care Quality – Decedents Having a Serious Illness or Age 72+ Auburn Folsom Area Your Panel 85 You 7 Reasons for Timely Followup Visits · Address Discharge Instructions · Med Rec · Re-visit Goals of Care Key Takeaway – Hospitalization in the Last 90 Days of Life Points to an Opportunity for: · Advanced Care Planning (ACP) · Palliative Care Referral · Earlier Hospice Referral Average Utilization During Last 90 Days of Life Average IP Days Your Panel 5.9 You 22.7 Average IP Admits 0.9 2.0 Average ER Visits 1.0 1.6 *Evidence of ACP noted in recent hospital discharges
Transcript of Panel Member 5 16.37 Panel Member 4 16.50 Panel Member …...Panel Member 6 15.81 Panel Member 7...
Improving End-of-Life Care Quality through Individualized PCP Reporting Michael Kersten, MPH; Terry Hill, MD; Nathaniel Robbins; Brook Calton, MD; Vidah Johnston, RN; Vicky Siauw, PharmD Hill Physicians Medical Group, San Ramon, CA: [email protected]
BACKGROUNDMedical groups, such as our independent physician association (IPA), and even health plans have usually lacked timely and complete data on deaths within their population. Without dates of death, health systems cannot discern patterns and variations of end-of-life care and quality across their populations. Thankfully, the California Department of Public Health (CDPH) has begun making this information available in rapid turn-around fashion. This poster shows how one IPA in Northern California is using this data to prompt individual physicians and regions to reflect on the quality of care given to their decedents.
PROJECT DESCRIPTIONPopulation views are invaluable for grasping systemic issues, but for a provider there is nothing comparable to seeing one’s own specific performance and the names of one’s own decedents. To create the provider report we envisioned, we partnered with our analyst to clean the data and prepare it for a clean pull into Tableau. We wanted to compare PCPs in the same area (“Your panel”) for key utilization measures in the last 90 days of life for members with serious illness or over the age of 72. The table in the upper right indicates how many of this provider’s decedents were coded as having advance care planning (ACP) before death. The patient level detail on the bottom shows data for each decedent: ACP prior to death, availability of a palliative care benefit (per health plan), and last 90 days utilization. As an IPA, we do not have hospice enrollment data. Only patients with one or more of the following were pulled into this report: age 72+, CHF, COPD, CKD, cancer, end stage liver disease, frailty, AIDS, MS, ALS, stroke, dementia.
METHODS• The project required us to apply to the CDPH for monthly death files that included
all California decedents. We received these files and ran our established matching process (EMPI) with a further logic that excluded any matched patients with post-death medical claims after date of death (DOD).
• Once DOD was established for matched HPMG patients, our analyst generated new data points for admits, bed days, and ER visits in the 90 days prior to death.
• We also determined whether decedents had ACP in the years prior to death, based on codes 99497/99498, yielding the table in upper right corner (Decedents With and Without Advance Care Planning).
• The End of Life Detail table on the bottom right shows the same data at the patient level, with the addition of health plan and palliative care (PC) benefit. PC benefits are specific to plan and geography, so we indicated instances where it would have been available for each decedent.
• Not shown are additional analyses of aggregate variation across disease states, multimorbidity, and age.
CONCLUSIONThe creation of this report is an innovative achievement for an IPA like ours—one that could not have been possible without the state’s policy shift and the many advocates who petitioned the CDPH. This report was rolled out to our 1,500 PCPs in the fall of 2018 with an ACP Provider Packet. While quantitative evaluation must await additional data, many of our providers have expressed deep concern at the low percentage of decedents with ACP and recognized the call to action.
Discharge Dt Patient ACP Code*
TCM Code
Has IP Followup
Visit
Visit Lag Time (Days)
4-0-18 Patient 1, Female, b.1927 No No No –
Patient 2, Female, b.1942 No No No –
3-27-18 Patient 3, Male, b.1932 No No No –
3-17-18 Patient 4, Male, b.1929 No No No –
Patient 5, Male, b.1938 No No No –
Patient 6, Male, b.1927 No No No –
3-08-18 Patient 7, Male, b.1956 No No No –
2-06-18 Patient 8, Male, b.1943 No No No –
2-04-18 Patient 9, Male, b.1934 No No Yes 2
1-27-18 Patient 10, Male, b.1956 No No Yes 4
1-19-18 Patient 11, Female, b.1941 No No Yes 7
1-16-18 Patient 12, Female, b.1954 No No Yes 4
1-16-18 Patient 13, Male, b.1932 No No No –
1-16-18 Patient 14, Male, b.1943 No Yes Yes 3
1-16-18 Patient 15, Male, b.1956 No No Yes 10
Patient DODLast
Office Visit Dt
Prior ACP HP PC Benefit ER
VisitsIP
DaysIP
Admit
Patient 1, Female, b.1931 2-15-18 2-8-18 No BS Yes, Most Areas 2 5 2
Patient 2, Male, b.1934 8-18-17 8-4-17 Yes BS Yes, Most Areas 2 27 3
Patient 3, Female, b.1943 7-20-17 7-17-17 No UH Yes, Outpatient 4 46 5Patient 4, Male, b.1926 10-25-17 10-24-17 No HN Yes, Limited 1 0 0
Patient 5, Male, b.1938 3-14-18 3-9-18 No UH Yes, Outpatient 0 3 1
Patient 6, Female, b.1931 8-18-17 8-4-17 No UH Yes, Outpatient 1 3 1
Patient 7, Male, b.1936 6-30-17 2-9-17 No UH Yes, Outpatient 1 75 2
Decedents Patient Death With ACP
ACP Percent
You 7 1 14.3%
Your Panel 85 17 20.0%
POST ACUTE AND SERIOUS ILLNESS: INPATIENT FOLLOW-UP CARE Q2 2017 THROUGH Q1 2018
POST ACUTE AND SERIOUS ILLNESS: END OF LIFE CARE QUALITY Q2 2017 THROUGH Q1 2018
Decedents With and Without Advanced Care Planning (ACP)
Inpatient Followup Visit Detail (Last 15 Admits) End of Life Detail
(Last 90 Days of Life)
© 2018 Hill Physicians Medical Group, Inc. | HP-MSCL18-009
2 4 6 8 10 12 14 16 18 20 22 24 26Number of Days
Decedents
Average Days from Discharge to Follow-up Visit for Patients Havong a Serious Illness or Age 72+ Auburn Folsom Area
End of Life Care Quality – Decedents Having a Serious Illness or Age 72+ Auburn Folsom Area
Panel Member 1 24.63Panel Member 2 20.29Panel Member 3 16.64Panel Member 4 16.50Panel Member 5 16.37Panel Member 6 15.81Panel Member 7 14.43Panel Member 8 13.12Panel Member 9 13.00
Goal (10 Days or Under)
Panel Member 10 12.27Panel Member 11 10.92Panel Member 12 10.76
Panel Member 13 9.00Panel Member 14 8.71Panel Member 15 8.47Panel Member 16 7.50Panel Member 17 7.33Panel Member 18 7.16Panel Member 19 6.83Panel Member 20 5.64
Your Panel 85You 7
Average UtilizationDuring Last 90 Days of Life
Average IP Days
Your Panel 5.9You 22.7
Average IP Admits
Your Panel 0.9You 2.0
Average ER Visits
Your Panel 1.0You 1.6
You 10.45
2 4 6 8 10 12 14 16 18 20 22 24 26Number of Days
Decedents
Average Days from Discharge to Follow-up Visit for Patients Havong a Serious Illness or Age 72+ Auburn Folsom Area
End of Life Care Quality – Decedents Having a Serious Illness or Age 72+ Auburn Folsom Area
Panel Member 1 24.63Panel Member 2 20.29Panel Member 3 16.64Panel Member 4 16.50Panel Member 5 16.37Panel Member 6 15.81Panel Member 7 14.43Panel Member 8 13.12Panel Member 9 13.00
Goal (10 Days or Under)
Panel Member 10 12.27Panel Member 11 10.92Panel Member 12 10.76
Panel Member 13 9.00Panel Member 14 8.71Panel Member 15 8.47Panel Member 16 7.50Panel Member 17 7.33Panel Member 18 7.16Panel Member 19 6.83Panel Member 20 5.64
Your Panel 85You 7
Average UtilizationDuring Last 90 Days of Life
Average IP Days
Your Panel 5.9You 22.7
Average IP Admits
Your Panel 0.9You 2.0
Average ER Visits
Your Panel 1.0You 1.6
You 10.45
Reasons for Timely Followup Visits · Address Discharge Instructions · Med Rec · Re-visit Goals of Care
Key Takeaway – Hospitalization in the Last 90 Days of Life Points to an Opportunity for:· Advanced Care Planning (ACP)· Palliative Care Referral· Earlier Hospice Referral
Average Utilization During Last 90 Days of Life
Average IP Days
Your Panel 5.9You 22.7
Average IP Admits
0.92.0
Average ER Visits
1.01.6
*Evidence of ACP noted in recent hospital discharges
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